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Agencies

Federal and State Agencies

QuestionAnswer
What is the name of the agency that was previously known as the Health Care Financing Administration? Centers for Medicare & Medicaid Services (CMS)
What is the name of the federal health program that started in 1965? Medicare
What are the 4 ways in which the beneficiary share in the cost of health care? Premiums, Deductions, Coinsurance charges and Payment for non-covered (excluded) services and charges.
Identify 3 groups in which individuals are eligible for Medicare? People who are 65 and older.
Name 4 services that are excluded from Medicare? Hearing Aids, Routine dental care, Routine eye care, Routine Foot care, Dentures, Acupuncture, PDN, Cosmetic Surgery, custodial care, Care rec'd outside of the US.
What does part D cover in Medicare? Prescriptions. In 2003 Congress enacted the Medicare Modernization Act and created the Medicare Part D Prescription Drug Program.
How was the Medicaid Program created? Title XIX of the Social Security Act. The program became law in 1965.
What is the primary differences between Medicare and Medicaid? Medicare is available for people over 65 regardless of income and benefits. The criteria is the same no matter where you are in the United States. Medicaid coverage is based strictly financial need. Eligibility requirements differ from state to state.
What does QMB stand for? Qualified Medicaid Benefits.
What is your state's Medicaid site? TX =
What does MFP stand for? Money follows the person. This program helps states rebalance their long-term care system to transition people with Medicaid from institutions to the community.
In what year did the Affordable Care Act become law? 2010
Name three initiatives developed under the Social Security Actand CMS that provides assistance to individuals who qualify for nursing home level of care in their homes and communities? Section 1115: Research & Demonstration Projects Section 1915 (b) Managed Care/Freedom of Choice Waivers Section 1915 (c) Home and Community-Based Service Waivers
What is the requirement needed for a person to be eligible for waiver programs? The individual will qualify for the services of a Nursing Home Facility, intermediate care facility for mental retardation, or intermediate care for other related conditions.
What type of approval is required for the waiver program? State Approval.
What is the name of the department that manages and oversees clinical programs for the member? Health Care Management Service Department
What is the primary objective for HCMS? Member will receive the right care at the right time
Created by: mayowd25